Education remains the foundational component of professional and practice preparation for advanced nurse practitioners. Dozens of programs are currently available to applicants who want to become nurses. However, while some of them pursue an associate degree in nursing, others choose to enter a bachelor-degree program. Differences in competencies between ADN- and BSN-prepared nurses have been extensively recognized: ADN-prepared nurses develop sufficient skills to provide excellent patient-centered nursing care, but their BSN-prepared colleagues go further to build higher-level communication, evidence-based practice, leadership, management, ethics, and technology competencies. In many clinical situations BSN-prepared nurses will be better positioned to make grounded decisions than their ADN-prepared colleagues, but it is better if they work collaboratively toward optimal patient and nursing outcomes.

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With the growing awareness of education and continuous learning as the critical factors of success in the nursing profession, differences between ADN- and BSN-prepared nurses have become a popular topic of research and discussions. The American Association of Colleges of Nursing (2012) suggests that the healthcare system needs a more qualified nursing workforce. Higher-level education creates favorable conditions for building advanced and enhanced professional nursing competencies, which improve patient and nursing outcomes. This is why the AACN (2012) says that education and outcomes are intricately related. The competencies and skills of nurses with an associate degree (ADN-prepared nurses) will certainly differ from the competencies and skills of nurses with a bachelor’s degree (BSN-prepared nurses).

ADN-prepared nurses graduate with the basic set of skills and competencies that are needed to fulfill routine nursing operations and functions in a clinical setting. They are graduate professionals who qualify for RN licensure (Matthias, 2015). ADN-prepared nurses possess the following competencies and skills: assessment, clinical decision making, communication, treatment administration, patient monitoring and follow-up, patient education, and collaboration (Nightingale College, 2016). They perform simple operations such as recording patients’ symptoms, ordering laboratory tests, providing communication, education and support to patients and their families, and handling routine patient care activities and tasks under the close supervision of a physician or a BSN-prepared nurse (Nightingale College, 2016). Nurses holding an associate degree work in entry-level technical positions but they continue their education and improve their career opportunities.

BSN-prepared nurses possess the same range of competencies and skills. However, because a bachelor’s nursing program lasts 4 years (instead of 2 years for an associate degree), BSN-prepared nurses go an extra mile to develop more advanced competencies and skills. According to the University College of Nursing Philosophy, baccalaureate nursing practice encompasses a whole spectrum of roles and functions such as critical thinking, assessment, care provision, leading, and teaching (education). Leadership, management, interdisciplinary collaboration, care coordination and care continuity, case management, and technology (or informatics) are among the fundamental competencies of BSN-prepared nurses. It is due to these skills and competencies that BSN-prepared nurses enjoy more freedom of clinical decision making and can perform simple medical procedures without physician supervision. BSN-prepared specialists can assume diverse roles and responsibilities and excel in a variety of clinical settings, including research and education (Matthias, 2015). Baccalaureate-level nursing practice covers disease prevention and health promotion, early diagnosis, and end-of-life care (University College of Nursing Philosophy). Not surprisingly, more hospitals seek to acquire and retain BSN-trained nurses. The debate over whether a greater proportion of BSN-prepared nurses can reduce patient mortality and improve clinical outcomes continues (Aiken et al., 2014; Yakusheva et al., 2014). However, it is obvious that BSN-prepared nurses are better positioned than their ADN-prepared colleagues to handle difficult or controversial patient situations.

For example, a 27-year-old patient is admitted to the hospital in a critical condition after a traffic accident. He does not have a living will or a written do-not-resuscitate order. Before he is taken to the intensive care unit, he shouts out so that everyone can hear: “If my heart stops, do not try to get me back to life!” Three hours later, the patient is declared to be in coma. His relatives, including his pregnant wife, insist that nurses should keep him alive. An ADN-prepared nurse will not be in a position to make any decisions regarding the patient’s health. He or she will have to perform routine nursing activities and operations according to the orders issued by a nurse supervisor or a physician. In contrast, a BSN-prepared nurse will have the leadership, communication and management competencies needed to step ahead and negotiate the situation with all stakeholders. For instance, a BSN-prepared nurse can make a note in the patient’s medical record that he does not want to be resuscitated. He or she can create a multidisciplinary team of professionals to evaluate the patient’s condition or collaborate with other physicians to reach a consensual decision on the optimal course of treatment for the client. Ultimately, a BSN-prepared nurse can initiate the provision of diverse health promotion and disease prevention resources to improve traffic safety and reduce the number of critically ill patients admitted to the hospital.

In either case, nurses will have to seek approval from a nurse supervisor or a physician. However, a BSN-prepared nurse will be better prepared than an ADN-prepared colleague to address the clinical and ethical issues raised by the patient and his caregivers. At the same time, it is better for ADN- and BSN-prepared nurses to work side by side to achieve mutually satisfying results. Collaboration, cooperation, communication, and mutual support can provide the best conditions for delivering excellent patient-centered nursing care.

In summary, ADN- and BSN-prepared nurses have different skills and competencies. Nurses with an associate degree have the skills and competencies required to perform routine nursing operations in entry-level positions under nurse or physician supervision. BSN-prepared nurses enjoy greater autonomy and freedom of decision making due to their advanced leadership, management, administrative, case management, technology, and ethics competencies. Nurses with associate degrees can strengthen their career positions if they continue their education. ADN- and BSN-prepared nurses should work side by side to handle the most controversial clinical situations and issues.

  • Aiken, L.H., Sloane, D.M., Bruyneel, L., Heede, K.V., Griffiths, P., Busse, R., … Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830.
  • American Association of Colleges of Nursing. (2012). Creating a more highly qualified nursing workforce. Retrieved from
  • Matthias, A.D. (2015). Making the case for differentiation of registered nurse practice: Historical perspectives meet contemporary efforts. Journal of Nursing Education and Practice, 5(4), 108-114.
  • Nightingale College. (2016). The real differences between ADN and BSN nurses. Retrieved from
  • Yakusheva, O., Lindrooth, R., & Weiss, M. (2014). Nurse value-added and patient outcomes in acute care. Health Services Research, 49(6), 1767-1786.